One Man’s Trash . . .

By Peter D. Kramer

April 23, 2010

Working with a patient he calls Debra, a compulsive hoarder, the psychologist Randy O. Frost tried a simple experiment. Frost proposed sending Debra a postcard, blank but for the name and address. Debra’s assignment was to throw it away.

Days later, Debra complained that she had not had enough time with the card. She described the stamp and the postmark. When she finally let go, she pictured the card’s position in the trash. Later, she confessed she had cheated by writing down everything about the card she could remember and then saving the notes.

In “Stuff: Compulsive Hoarding and the Meaning of Things,” Frost, a professor at Smith College, and Gail Steketee, a professor and dean of the school of social work at Boston University, invite us graciously into territory that might otherwise make us squirm. They have spent nearly 20 years working with hoarders, sometimes in settings where tunnels lead through trash and roaches roam freely. Frost and Steketee introduce collectors who acquire through shopping, Dumpster diving and stealing. The resulting assemblages encompass broken machines and living things (cats and dogs, mostly).

People justify hoarding as curating and recycling, deeming odd objects beautiful and useful. Sometimes they act as if history were at stake. Andy Warhol, “straddling the border between eccentricity and pathology,” the authors write, would periodically sweep everything — cash, artwork, apple cores — off his desk and into a cardboard box. He stored hundreds of these “time capsules.”

To characterize hoarding, Frost and Steketee select what they call a “prototype” case involving a woman named Irene. Irene’s home is filled with seemingly random items: newspapers, children’s games, empty cereal boxes, expired coupons. The mess has driven Irene’s husband from the house, and she worries that he will seek custody of their children, including a daughter whose dust allergies make it hard for her to live there.

To Frost and Steketee, patients like Irene demand a new understanding of hoarders. Past experts have depicted sufferers as isolated and paranoid — deprived in childhood and now unable to discard worthless junk even when it bears no sentimental value. But Irene’s parents were comfortable financially. She has many friends. She treasures each item she owns and anticipates putting it to future use.

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Credit...Illustration by R. O. Blechman

Hoarding has been linked to obsessive-compulsive disorder and its variants, and Irene, who displays contamination fears, probably meets criteria for O.C.D. But studies show that the genetics of hoarding differ from the genetics of obsessing. And while obsessionality is painful, Irene finds enjoyment in acquiring and revisiting her holdings. It is this pleasure in objects (think of Debra and the postcard) that distinguishes hoarding, in Frost and Steketee’s view. They suggest that hoarders may “inherit an intense perceptual sensitivity to visual details,” and speculate about “a special form of creativity and an appreciation for the aesthetics of everyday things.”

This upbeat account of hoarding’s basis has a humane ring: hoarders are discerning. But then, Irene can be indiscriminate, according every possession equal worth, whether it’s a newspaper clipping or a photograph of her daughter. Frost and Steketee are too thoughtful to give a simple account of what drives Irene. Possessions help her preserve her identity and relive past events. The objects make her feel safe and allow her to express caring. Newspaper clippings point outward, speaking to Irene of opportunities in the wider world. Irene is depressed; collecting promises relief. Irene displays perfectionism and indecisiveness, character traits that have been linked to hoarding. When there are so many motivations, no single one seems central.

Hoarding can also arise in connection with senility, injuries to the brain’s frontal lobes and Prader-Willi syndrome, a genetic disorder whose symptoms may include low intelligence. Ideally, any theory that ascribes a special aesthetic sensibility to hoarders would need to take account of patients whose thought processes are impaired. And as Frost and Steketee demonstrate, there is no end to competing explanations of how hoarding arises. The “terror management theory” holds that collecting mitigates fears of death, via the fashioning of a form of immortality. The “compensation theory” postulates that objects can provide reassurance to those who question their self-worth. Hoarding has been linked to gambling addiction; acquisition is a matter less of compulsion than of impulsivity. Frost and Steketee also connect hoarding with modern materialism and advertising (though they stress that materialism is associated with display and hoarding with secrecy); then again, they emphasize the condition’s universality.

Certainly, collecting is a common human activity. One hoard, 1,100 seal impressions on clay from the Fertile Crescent, has survived 25 centuries. As many as 90 percent of children collect something, Frost and Steketee report, and two-thirds of American households include a collector.

What separates pastime from disorder? Frost and Steketee rely on distress and impairment, criteria that psychiatry employs to delineate diagnoses. But some of the subjects Frost and Steketee discuss function well enough. What of the wealthy, cultured twins, each of whom has stuffed a hotel penthouse with moldering artwork? Both brothers have friends. Both can afford to move to new apartments as old ones fill up. Both take pride in their collections. Are the twins ill? If not, is it resources that set them apart from Irene, who is struggling to hold on to her children? It seems paradoxical that if one twin were to become desperate because he recognized that he had lost control, he might be labeled a pathological hoarder, while his brother, blithely rationalizing his purchases, would be deemed healthy.

As Frost and Steketee’s examples multiply, hoarding comes to seem an ever more diffuse concept. A majority of the subjects the authors study are clinically depressed. Frost and Steketee believe that hoarding causes the mood disorder. Working in different terrain, I see patients who complain first of depression. Twice, I have treated women who lived amid clutter because they could not discard the detritus of daily life, be it magazines or pay slips. I had no success with the filled rooms. But both times we made progress with the depression, and both times the patient moved, for business reasons. In the new house, each managed to keep up with the flow of paper.

Frost and Steketee, with their active collectors, do not see this sort of result. Forced clean-outs don’t work; hoarders restock houses quickly, and the sudden loss of objects causes rage and anxiety. (Nantucket, we learn, stopped town-­ordered cleanups when three hoarders died shortly after the interventions.) Frost and Steketee recommend self-help groups and variants of cognitive therapy to treat hoarding. Success is mixed. Clients report improvement, but their homes remain cluttered. One O.C.D. researcher tells Frost and Steketee that she excludes hoarders from her samples because they make therapy outcomes look bad — quite a statement when you consider that she is confronting a notoriously unyielding disease.

If Frost and Steketee have difficulty constructing a coherent new vision of compulsive hoarding, it is because they are too observant and too dedicated to the relief of suffering to make a complex phenomenon simple. They are collectors in their own right, stocking a cabinet of curiosities with intimate stories and evocative theories. To those who need to understand hoarders, perhaps in their own family, “Stuff” offers perspective. For general readers, it is likely to provide useful stimulus for examining how we form and justify our own attachments to objects.